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The fact is that drug overdoses now outnumber car crashes in terms of fatalities in the U.S., with 80 people dying every day just from opioid overdose. Yet two decades ago, drug deaths weren’t even on the radar for most Americans.

As you can see from the 1999 map, overdose deaths were rare in much of the country, with the exception of some high mortality rates in parts of Appalachia, the Southwest, and Northern California. Though even then, you could see the potential for explosion in OD deaths in the Pacific Northwest, New England, Florida, Oklahoma, and the Midwest.

At the time, drugs like OxyContin were new to the market and promising long-acting relief for sufferers of chronic pain. That made the drug more attractive to people who injured themselves doing work that puts a high demand on one’s body — mining, farming, manufacturing.

People also realized that they could get around the extended-release aspect of these drugs by simply pulverizing the pills and ingesting all the contents at once. This resulted in a better high from the drug, but also increased the risk of dependency and overdose.

Fast-forward to 2014, and the map looks significantly darker, as the problem areas from 1999 have only gotten worse and spilled out to cover larger regions, and it’s now more rare to have a low overdose death rate:

Florida, which had some low-level areas of overdose deaths in 1999, became known on a national level as a place where scoring pain pills was easier than it should be. Major drug store chains were caught turning a blind eye to fake or questionable prescriptions.

As the Guardian notes, this region of the country had largely been in line with the national increase in overdose deaths until recent years, when states like New Hampshire and Massachusetts saw spikes from fatalities related to the powerful painkiller fentanyl.

Speaking of fentanyl, that drug is one of the concerns about the current efforts to further restrict access to prescription painkillers.

Alexander Walley, a physician and director of addiction consultation services at Boston Medical Center, tells the Guardian that “what we’re seeing now is that even as you reduce access to prescription opioids, you’re seeing an explosion of heroin use and heroin overdoses – and then there’s also now this ultra-potent substance [fentanyl] sold as heroin.”

And it’s not just fenantyl-spiked heroin that’s a problem. Addicts who can’t get their hands on prescription drugs through pharmacies are turning to drug dealers, who sometimes sell knock-offs containing drugs even more dangerous than the sought-after painkillers.